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HomeMy WebLinkAbout289879 UNITED MAILING - INSURANCE CERTIFICATE (2)Statefarm STATE FARM FIRE AND CASUALTY COMPANY $_ A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED JUL 17 2014 1555 y �8 38�1tg01 Policy Number 96-KJ3330-6 T-20-2359-FAF1 F U 001849 3123 Addl Insured -Section II Only CITY OF FORT COLLINS ATTN: PURCHASING DEPT PO BOX 580 FORT COLLINS CO 80522-0580 Office Policy Policy Period Effective Date Expiration Date 12 Months JUN 1 2014 JUN 1 2015 The policy period beg9ins and ends at 12:01 am standard time at the premisesTocation. Named UNIT DInsuMAILING 3201 E MULBERRY ST UNIT D FORT COLLINS CO 80524-8475 Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Entity: Corporation Reason for Declarations: Your policy is amended JUL 17 2014 ADDITIONAL INSURED ADDED FORM CMP-4786 ADDED Endorsement Premium Increase Discounts Applied: Renewal Year Years in Business Enclosed Building Sprinkler Claim Record 44.00 Prepared AUG 11 2014 ® Copyright State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 015791 290 Al Continued on Reverse Side of Page N Page 1 of 6 caaexv.v nc.m.vm� e,uavma DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-KJ-3330-6 SECTION I - PROPERTY SCHEDULE Location Location of Limit of Insurance' Limit of Insurance' Seasonal Number Described Increase - Premises Coverage A - Coverage B - Business Buildings Business Personal Personal Property Property 001 3201 E MULBERRY ST UNIT D No Coverage $ 221,800 25% FORT COLLINS CO 80524-8475 As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the limit due to Inflation Coverage. SECTION I - INFLATION COVERAGE INDEXES) Cov A - Inflation Coverage Index: Gov B - Consumer Price Index: SECTION I - DEDUCTIBLES N/A 234.8 Basic Deductible $1,000 Special Deductibles: Money and Securities $250 Employee Dishonesty $250 Equipment Breakdown $1,000 Other deductibles may apply - refer to policy. Prepared AUG 11 2014 © Copyright. State Farm Mutual Automobile Insurance Company, 20D8 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 0157e1 Continued on Next Page Page 2 of 6 Statye�Frm ya W- DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-KJ-3330-6 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless indicated by "See Schedule." If a coverage does not have a corresponding limit shown below, but has 'Included" indicated, please refer to that policy provision for an explanation of that coverage. LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises $50,000 Off Premises $15,000 Arson Reward $5,000 Back -Up Of Sewer Or Drain $15,000 Collapse Included Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Coverage B Limit Debris Removal 25% of covered loss Equipment Breakdown Included Fire Department Service Charge $5,000 Fire Extinguisher. Systems Recharge Expense $5,000 Forgery Or Alteration $10 000 Glass Expenses Included Increased Cost Of Construction And Demolition Costs (applies only when buildings are 10`/0 insured on a replacement cost basis) Money And Securities (Off Premises) $5,000 Money And Securities (On Premises) $10,000 Money Orders And Counterfeit Money $1,000 Newly Acquired Business Personal Property (applies only if this policy provides $100,000 Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage A - Buildings) Prepared AUG 11 2014 © Copyright, State Farm Mutual Automobile Insurance Company, 2000 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 015792 290 Continued on Reverse Side of Page Page 3 of 6 N DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-KJ-3330-6 Ordinance Or Law - Equipment Coverage Included Outdoor Property $5,000 Personal Effects (applies only to those premises provided Coverage B - Business $5,000 Personal Property) Personal Property Off Premises $15,000 Pollutant Clean Up And Removal $10,000 Preservation Of Property 30 Days Property Of Others (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Signs $2,500 Unauthorized Business Card Use $5,000 Valuable Papers And Records On Premises $50,000 Off Premises $15,000 Water Damage, Other Liquids, Powder Or Molten Material Damage Included SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - PER POLICY The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations. COVERAGE Dependent Property - Loss Of Income Employee Dishonesty Utility Interruption - Loss Of Income Loss Of Income And Extra Expense LIMIT OF INSURANCE $5,000 $10,000 $10,000 Actual Loss Sustained - 12 Months Prepared AUG 11 2014 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 0157e2 Continued on Next Page Page 4 of 6 SfateFarm JL- DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-KJ-3330-6 SECTION II - LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $1 000 000 Coverage M - Medical Expenses (Any One Person) $5 000 Damage To Premises Rented To You $300 000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate $2,000,000 General Aggregate $2,000,000 Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II - Liability in the Coverage Form and any attached endorsements. Your policy consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. FORMS AND ENDORSEMENTS CMP-4100 Businessowners Coverage Form CMP-4786 'Addl Insd Owners Lessee Schad CMP-4206.1 Amendatory Endorsement FE-6999.1 Terrorism Insurance Cov Notice CMP-4819.1 Unauthorized Business Card Use CMP-4706 Back -Up of Sewer or Drain CMP-4704 Dependent Prop Loss of Income CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4703 Utility Interruption Loss Incm CMP-4705 Loss of Income & Extra Expnse CMP-4802 Addl Insd Lessor of Leased Eqp CMP-4875 Loss Payable Prepared AUG 11 2014 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 015793 290 Continued on Reverse Side of Page Page 5 of 6 N DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-KJ-3330-6 CMP-4788 Addl Insd Mgrs Lessor of Prem FD-6007 Inland Marine Attach Dec . New Form Attached This policy is issued by the State Farm Fire and Casualty Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation, as amended. In Witness Whereof, the State Farm Fire and Casualty Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. Secretary President Prepared AUG 11 2014 CMP-4000 © Copyright State Form Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 015793 290 N Page 6 of 6 Statefarm STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS Gee7W P6699-5901 T-20-2359-FAF1 F U Named Insured UNITED MAILING 3201 E MULBERRY ST UNIT D FORT COLLINS CO 80524-8475 ATTACHING INLAND MARINE Policy Number 96-KJ3330-6 Policy Period Effective Date Expiration Date 12 Months JUN 1 2014 JUN 1 2015 The poll y period begins and ends at 12:01 am standard tame ate premises Tocatlon. Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effectfor each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Annual Policy Premium Included The above Premium Amount is included in the Policy Premium shown on the Declarations. Your policy consists of these Declarations, the INLAND MARINE CONDITIONS shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequentto the issuance of this policy. Forms, Options, and Endorsements FE-8739 Inland Marine Conditions FE-8743 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared AUG 11 2014 © Copyright State Form Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 015794 530 586 a2 05-31-201110 I f3232cI 96-KJ-3330-6 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF NUMBER COVERAGE INSURANCE FE-8743 Inland Marine Computer Prop S 25,000 Loss of Income and Extra Expense S 25,000 Prepared AUG 11 2014 FD-6007 DEDUCTIBLE AMOUNT $ 500 OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY © Copyright State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ANNUAL PREMIUM Included Included 015794 530 686 e.3 05 31 2011 W113333c1 stateFarm 96-KJ-3330-6 015795 CMP-4786 A. Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OCMP-4786 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 96-KJ-3330-6 Named Insured: UNITED MAILING 3201 E MULBERRY ST UNIT D FORT COLLINS CO 80524.8475 Name And Address Of Additional Insured Person Or Organization: CITY OF FORT COLLINS ATTN: PURCHASING DEPT PO BOX 580 FORT COLLINS CO 80522-0580 SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily in- jury", "property damage", or "personal and advertising injury" caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or b. Products -Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard". 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit' brought for damages for which you are provided coverage. 3. Primary Insurance. The insurance afforded the additional insured shall be primary insur- ance. Any insurance carried by the additional insured shall be noncontributory with respect to coverage provided by you. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. CMP-4786 ®, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission.